Provider Demographics
NPI:1568911683
Name:BEHAVIORAL STRIDES THERAPY
Entity Type:Organization
Organization Name:BEHAVIORAL STRIDES THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:561-336-0358
Mailing Address - Street 1:5850 ATLANTIC AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8427
Mailing Address - Country:US
Mailing Address - Phone:561-336-0358
Mailing Address - Fax:
Practice Address - Street 1:5850 ATLANTIC AVE STE 112
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8427
Practice Address - Country:US
Practice Address - Phone:561-336-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013209097OtherNPI
FL1649532383OtherNPI